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Impact sociétal de la vaccination : au-delà de la protection individuelle Regain d’intérêt face à la pandémie COVID-19 ?

Authors:

Abstract

L’hésitation vaccinale est croissante dans le monde, nuisant aux efforts de contrôle des maladies infectieuses. Les professionnels de la santé jouent un rôle important dans l’acceptation de la vaccination. Une conscientisation sur les effets bénéfiques de la vaccination est une des stratégies conseillées par l’OMS afin de contrer l’hésitation vaccinale. Au-delà de la protection individuelle vis-à-vis d’un pathogène, la vaccination est associée à une protection au niveau de la communauté. Dans cette revue narrative de la littérature, les effets sociétaux de la vaccination, au sens large, sont résumés. Les bénéfices incluent une meilleure probabilité de profiter d’une éducation complète, une augmentation de la productivité et un impact fiscal positif, la limitation des inégalités hommes-femmes et la prévention d’épidémies coûteuses. Les bénéfices larges de la vaccination doivent faire partie de la communication au sujet de l’impact de la vaccination et intégrer les programmes éducationnels destinés aux futurs professionnels de la santé. La pandémie liée à la COVID-19 a un impact social et économique sévère et est l’illustration paroxystique d’un monde sans vaccin. Malgré cela, des enquêtes récentes ont montré que l’acceptation d’un futur vaccin prévenant le SARS-CoV-2 ne sera pas automatique et illustrent l’importance d’une communication également axée sur la sécurité et la tolérance d’un futur vaccin.
170
Rev Med Liege 2020; 75 : Supplément : S170-S175

Impa c t s o c I é tal de la va c c I n atIon :
au-delà de la protectIon IndIvIduelle
reg a In dIn tér êt fa ce à la pa nd é mI e covId-19 ?
s
ocIetal
Impact
of
vaccInatIon
:
beyond
IndIvIdual
protectIon
.
r
enewed
Interest
followIng
covId-19
pandemIc
?
s
ummary
:      

   
      


     


      
    
     
       
      


      
   


  


K
eywords
: Vaccination - Herd immunity - Benefits -
Investment - Outbreaks - COVID-19 - SARS-CoV2
r
ésumé
:      
       
       
       


  


     

  
        
      
      
   
         

          
   
       
  

     

m
ots
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clé s
: Vaccination - Immunité de groupe -
Bénéfices - Investissements - Épidémies - COVID-19 -
SARS-CoV-2
     

  

     
      

    
        
     


  


      
      

 


      
    

   
     

      


      
      


Intr o d u ctIon
     




     
     

      
      
    
  

       

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Rev Med Liege 2020; 75 : Supplément : S170-S175
Impact socIétal de la vaccInatIon : au -delà de la pro tectIon IndI vIduelle

     
     
   

     
     
      

      
    
       


      

       
      
       



Immu n I t é de gr o u p e et p r o t ectIo n
de l a c o mmuna u t é

 
       



  


   



  Hae-
mophilus influenzae      

   

    
     
      
   Streptococcus pneumo-
niae       


  
 
     


conc e p t s : e ffet s é t roIts v e r s u s
eff e t s large s d e la vaccI n at I o n
 
      



     
     

     

     
  

    
     

    

     

  
      
     

     
       
      

  Streptococcus pneumoniae  
     
    

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      
     
      
     


      
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 
 
 
      
     
Haemophilus influenzae
   Streptococcus pneumoniae
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Rev Med Liege 2020; 75 : Supplément : S170-S175
Dauby N
  
     
 Neisseria meningitidis  



       
       
     
  
        
      
      
      
        

  

        


  


        
     

        
      
     

  



bé f I c es lar g e s de la
va ccIn atI o n : é t u des r é a l Isées
dans les pays à hauts r e v e nus
      
     
  
       


  
  
  
      
  



       

   





      
      



      
      
  
      
     
Tableau I. Effets larges de la vaccination au niveau sociétal (adapté des références 11, 14).
 



 haemophilus
 

 


 haemophilus

 


 




 

 
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Rev Med Liege 2020; 75 : Supplément : S170-S175
Impact socIétal de la vaccInatIon : au -delà de la pro tectIon IndI vIduelle

      
  
     
      

    
       
      
     
      


     



    
       
        
        
     
        
   
       
         
       
  

    
  

   
 
      


le c t dune é p IdémI e
   

     
     



     
     
     
   
   


      
      

      
       
     

        

       
        
       
       
   

 

vacc I n at I o n et ég a l I té
hom m e s -femme s
 
     

        

 

      


      
     
       
 

  

      
     
in utero



       




    
       


       
  

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Rev Med Liege 2020; 75 : Supplément : S170-S175
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       

       
      
      
    
     
      
      

      

    
      


      


    
       
      
    
      
     
      


     
  
      
  
     
      
     


     
      
        
      
      
    
   
   
     
  


 
     
     

      
     
  
  
     


       

c
onc l u s Ions
      
    

    

  


     
    
      
      
     



     

    
       

Remarques
     
        
       


b
Ibl I o g raphI e
         
  
    

           

EBioMedicine12
        
Vaccine33
        
    
Lancet Infect Dis20
     
 Am J
Prev Med53
  
       
Vaccine37
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Rev Med Liege 2020; 75 : Supplément : S170-S175
Impact socIétal de la vaccInatIon : au -delà de la pro tectIon IndI vIduelle
  
   

Vaccine36
 
       
  

        
Clin Infect Dis52
         
   Clin Infect Dis
67
           
  
BMC Med13
 
Sci Transl Med 10
         
   
    Clin Microbiol Infect
18
 
Proc Natl Acad Sci 111
         

  Trop Med
Int Health5
 
   
J Infect 62
 
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Bull World Health Organ95
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Health Aff 35
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Pediatrics133
      
 Risk
Anal 26
       

 
     Int J Technol Assess
Health Care36
        
  

          
EMBO Mol Med10
          
    
    Bull World Health Organ
87
     

Infect Dis50
          
         
      
     Gynecol Oncol
105
 
    
PLoS ONE8
     
 
      

 
        
      Health
Policy Plan34
          
    

   

          
Can Respir J2017
           
  
N Engl J Med383
  

    
LancetS0140-6736
 
N Engl J Med
383
          
    
Clin Microbiol Infect 18
            
    
  


         
   
Eur J Epidemiol 35
     



           
   
   Hum Vaccines Immunother
1-8
         
   
Vaccine34
    
J Mark Access Health Policy 3
 
 
Open Forum Infect Dis 7
      
  
Nature581
 
       Int J Environ Res
Public Health17
 
       Trends
Parasitol 34
         
      


... Despite the fact the COVID-19 vaccine is one of the most effective tools for preventing the disease and fighting against the virus, its acceptance around the world is rather low. This emphasises the importance of education and communication regarding its effectiveness and benefits in relation to both physical health and psycho-social behaviour, especially now as a move towards the prospect of a booster dose has been made to achieve sufficient immunization coverage and end the global pandemic [13]. ...
... Good health is a key input of economic growth, thus, by increasing the level of human capital the economic productivity of people and a country is enhanced. Implementation of successful vaccination programmes is the key factor for not only avoiding business disruptions, but also social distancing [13], therefore their assessment is measured at the public level rather than the individual one [33; 34]. ...
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Coronavirus disease (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) that is highly contagious and transmissible through respiratory droplets. At the beginning of 2020, the rapid infectious outbreak and a lack of effective pharmaceutical treatment provoked one of gravest health emergencies in modern history and a global pandemic bringing tremendous health, social and other challenges. The virus does not only spread and cause the disease, and in some cases even death, but also leaves a significant impact on human wellbeing and behaviour. Enforced regional and national lockdowns, closure of educational establishments, workplaces and entertainment venues, social distancing and isolation reduced the transmission of the virus and helped control the further spread of the disease, however the restrictive measures consigning people to stay in their homes affected their mental health and the dynamics of their social interactions. Multiple emotional and psychological conditions, including fear, anxiety, irritability, grief, exhaustion and depression, were triggered by both being directly affected by the disease (i.e. diagnosed with COVID-19 and having a symptomatic treatment) and experiencing overall pandemic-induced stress. The review paper is aimed at identifying and synthesizing relevant literature to determine and assess people’s psycho-social health benefits of vaccination and immunization against COVID-19. To conduct the research, electronic searches were made in Google Scholar, Medline and PubMed databases, as well in the World Health Organization’s COVID-19 research article directory. The findings of the review reveal that COVID-19 vaccines are key to ending the coronavirus pandemic. Vaccination protects people’s physical health by building up immunity and defending the body against the targeted disease; it also increases the safety and amount of their social activity, mobility and interpersonal relationships thereby reducing anxiety and depression. Thus, by safeguarding both their physical and psycho-social health, a gradual return to a more normal life is being ensured. Comprehension of the determinants of individuals’ decision-making process regarding vaccination and establishment of effective strategies for supporting public health and wellbeing policies are of crucial importance for the recovery from the global health and socio-economic catastrophe.
... Phát triển vaccine an toàn, hiệu quả và mở rộng quy mô tiêm chủng toàn dân là cách tiếp cận an toàn và khả thi nhất để ngăn ngừa COVID-19 một cách hiệu quả và bền vững [10]. Tiêm phòng COVID-19 giúp bảo vệ cơ thể khỏi COVID-19, giảm nguy cơ mắc bệnh nặng, nhập viện, tử vong và thiết lập khả năng miễn dịch cộng đồng, tạo điều kiện để phục hồi và phát triển kinh tế [2], [9]. Với yêu cầu: hiệu quả bảo vệ cơ thể khi tiếp xúc với virus COVID-19, an toàn với cơ thể và khả năng sinh miễn dịch tốt, hiện nay có 8 loại vaccine được cấp phép và sử dụng phổ biến tại Việt Nam. ...
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Đặt vấn đề: Phát triển Vaccine an toàn, hiệu quả và mở rộng quy mô tiêm chủng toàn dân là cách tiếp cận an toàn và khả thi nhất để ngăn ngừa COVID-19 một cách hiệu quả và bền vững. Tiêm phòng COVID-19 giúp bảo vệ cơ thể khỏi COVID-19, giảm nguy cơ mắc bệnh nặng, nhập viện, tử vong và thiết lập khả năng miễn dịch cộng đồng, tạo điều kiện để phục hồi và phát triển kinh tế. Mục tiêu nghiên cứu: Nghiên cứu được thực hiện với 3 mục tiêu: (1). Mô tả kiến thức về tiêm vaccine COVID-19 mũi nhắc lại, (2). Mô tả thái độ về tiêm vaccine COVID-19 mũi nhắc lại, (3). Tỷ lệ tiêm vaccine COVID-19 mũi nhắc lại 1 của người dân tại tỉnh Bình Dương. Đối tượng và phương pháp nghiên cứu: Nghiên cứu cắt ngang mô tả trên 2140 người dân từ 18 tuổi trở lên trên địa bàn tỉnh Bình Dương. Kết quả: Qua nghiên cứu có 14/14 câu hỏi về kiến thức đều có trên 50% người dân có kiến thức đúng, 9/9 câu hỏi về thái độ có 80% người dân có thái độ tích cực. Tỷ lệ tiêm vaccine COVID-19 mũi nhắc lại 1 là 76,4%. Kết luận: Cần tiếp tục thực hiện các hoạt động truyền thông giáo dục về tác dụng của vaccine, lợi ích của tiêm nhắc lại. Đồng thời, cần triển khai rà soát, cung cấp lịch tiêm vaccine COVID-19 nhắc lại phù hợp với từng người dân trong tỉnh.
... Indeed, vaccine awareness was the only consistent a significant variable associated with vaccine acceptance and its recommendation to patients and family in this study. Increased awareness on advantages of vaccination is a recommended strategy to counter vaccine hesitancy, 30 while lack of awareness is considered a main barrier that compromises providers' communication about vaccines 31 . Furthermore, availability of time and building a doctor-patient relationship based on trust are essential factors for successful efforts in recommending vaccines to patients 32 . ...
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This study aims to explore vaccine acceptance and recommendation behaviors among clinical dental students and their faculty who were previously infected with SARS-CoV-2. The study was conducted among previously infected dental healthcare personnel (DHCP) in an academic setting to evaluate their willingness to accept vaccines and recommend them to family and patients. Logistic regression was conducted to determine significant variables associated with vaccine attitudes. Among 316 personnel 62 indicated previous infection (19.6%). Personnel who were willing to take the vaccine, or recommend it to patients, or to family were: 67.7%, 87.1%, and 85.5% respectively. Vaccine acceptance was significantly associated with vaccine awareness and number of long-term COVID-19 complications (P=.003, .033 respectively). Vaccine recommendation to family, and patients was significantly associated with vaccine awareness only (P=.005, .006 respectively). It is concluded that some previously infected academic dental personnel are unwilling to accept COVID-19 vaccines or recommend them to others. This was mainly due to lack of vaccine awareness. Efforts directed at increasing COVID-19 vaccine awareness are warranted by dental schools in collaboration with Ministry of Health authorities. It is also necessary to closely monitor, and provide support to personnel affected by long COVID
... Vaccine hesitancy is one of the greatest threats to global health (3), and the benefits of the vaccine will be significantly hampered if there is severe hesitation to receive the COVID-19 vaccine (4). COVID-19 vaccination protects individuals from COVID-19 and establishes herd immunity and has broad benefits at the social level in terms of increased production and positive financial impact (5). Addressing COVID-19 vaccine hesitancy is significant for promoting vaccination, health protection, and social development (6). ...
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Objective This study aimed to explore COVID-19 vaccine hesitancy in Chinese adults and analyzed the relationship between knowledge, attitudes, practices (KAP), and COVID-19 vaccine hesitancy. Methods A population-based self-administered online survey was conducted in Taizhou, China to evaluate the population's hesitancy to receive COVID-19 vaccination. A total of 2.463 adults received the invitation for the survey through WeChat (A Chinese app that is used for chat, social media, and mobile payment), and 1.788 interviewees answered the structured questionnaire. The overall response rate was 72.6%. Results Total 45.2% of people were hesitant about the COVID-19 vaccination. Using binary logistic regression analysis, we found low perception of safety (Model 3: Odds ratio = 2.977, Confidence interval: 2.237–3.963) and efficacy (Model 3: OR = 1.904, 95%CI: 1.462–2.479) of the COVID-19 vaccine in adults is the most important risk factor for COVID-19 vaccine hesitation. People who know more about COVID-19 vaccination are less hesitant (Model 2: OR = 0.967, 95% CI: 0.951–0.983). People who did not seek information independently about the COVID-19 vaccine are more likely to be skeptical (Model 4: OR = 1.300, 95% CI: 1.058–1.598, P = 0.013). Conclusion In China, the population had higher levels of COVID-19 vaccine hesitation, and their knowledge of the COVID-19 vaccine, perceptions of safety and efficacy, and physical health status were significantly associated with vaccine hesitation. These results provide ideas for promoting COVID-19 vaccination and intervention and have far-reaching implications for further strengthening research on vaccine hesitancy in COVID-19 and exploring strategies for COVID-19 vaccine promotion.
... Moreover, vaccination for Covid-19 ensures social safety and individual protectiveness . Those, who are already vaccinated, went back to their habituated social and economic activities irrespective of the pandemic situation (Dauby, 2020;Rodrigues & Plotkin, 2020). Our findings also indicate that people for ensuring health safety prefers vaccinations and they are most enthusiastic to take vaccines for personal and social protection as hypothesis H2 and H3 were accepted. ...
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The Covid-19 pandemic has created enormous challenges for civilization as almost every aspect of life, including food production, economic activities, health security, education, entertainment, and global exchange, is affected. Modern human civilization has never experienced such an outlandish situation before. Consequently, pandemic fear notably has influenced consumers' perception and buying behavior. This study aims at understanding consumers' shopping behavior after getting vaccinated and the mediation effect of vaccination on shoppers' perception to resume offline shopping during the covid-19 outbreak. Conducting an extensive field survey among different levels of adults in Bangladesh, using the Partial Least Square method, this research found that the pandemic fear is a minor factor in continuing offline shopping if a proper vaccination process is ensured. The findings of the study have momentous theoretical, methodological, and practical contributions to the research area and researchers will be able to understand how vaccination mediates the relationship between different social and economic dependent and independent variables.
... However, given themes related to the COVID-19 vaccine hesitancy, such as vaccine efficacy, safety, pace of development, and fear of side effects, it is important for health care providers and public health officials to have information available as these groups play a critical role in combating vaccine hesitancy. 22,[33][34][35] Of note, only 0.00068% (1,445/2,120,350) of COVID-19 vaccine doses given from December 11, 2021 to May 13, 2021 were associated with a report in VAERS, showing a particularly low rate of reactions associated with these vaccines thus far. By providing a clear statistical overview of the AERs associated with these vaccines, this study may be utilized as a resource for individuals and their medical providers to make informed and educated decisions on whether to receive a COVID-19 vaccine. ...
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Introduction. Coronavirus disease 2019 (COVID-19) is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and has spread rapidly throughout the world since its discovery in 2019. Three vaccines (Pfizer-BioNTech, Moderna/NIAID/BARDA, and Johnson & Johnson’s Janssen) have been developed for use in the U.S. to aid in the fight against this virus, but have been scrutinized intensely for their efficacy and safety. It is important to understand and interpret the adverse events or reactions (AERs) associated with these vaccines in an objective and analytical manner. The goal of this descriptive study was to provide a resource outlining AERs associated with the three available vaccines in Kansas. Methods. Reports were obtained from the Vaccine Adverse Event Reporting System (VAERS), representing AERs observed in Kansas from December 11th, 2020, to May 13th, 2021. All data were screened and coded, and descriptive statistics were used to describe AERs based on vaccine manufacturer, age, gender, and reported deaths. Results. Only 0.068% of COVID-19 vaccines doses given were associated with an AER. The most common AERs were fatigue/tiredness, tingling/itching, fever, hives, and muscle/joint paint. Only 0.002% of reports to VAERS were associated with a death. The majority of reports were by females (78.8%) and those aged 30 to 39 (20.6%). Conclusions. No reported AERs were unexpected compared to national data, and no VAERs report provided a causal relationship between vaccine administration and death. Vaccines are, and will continue to be, essential tools to fight COVID-19. Providing a resource of potential AERs could aid in individual decisions to receive a vaccine and may help in the control of COVID-19.
Conference Paper
World Health Organization (WHO) studies indicate that people with pre-existing diseases are prone to suffer the severity of the effects of COVID-19 in case of infection. This work presents a mobile application development through open-source software and machine learning techniques for the prediction of the COVID-19 severity in an individual based on pre-existing disease information. For the prediction of the severity and to determine the possibility that an individual ends up in an intensive care unit (ICU), we set a machine learning algorithm, which resulted in a higher probability of prediction when the user undergoes cases of pre-existing diseases, with an efficiency rate of 98 %. We carried out load and stress testing to verify the processing performance, battery consumption, startup latency, and maximum amount of user connections supported by the application, complemented with a wristband for individual's real-time monitoring to attain low battery consumption when using public cloud services and low-power technologies for the connection.
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Objective: Publications on vaccine hesitancy and the novel coronavirus disease 2019 in the scientific literature are increasing every day. An examination of their content will help to eliminate the existing negativity related to vaccine hesitancy through scientific methods. Hence, a systematic approach to the prevention of vaccine hesitancy worldwide can be developed. This article aims to survey how vaccine hesitancy is addressed in the PubMed articles about "vaccine hesitancy" over the novel coronavirus disease, for which the MeSH criteria have been published; to understand their recommendations for the prevention of vaccine hesitancy; to evaluate any related research described as "cross-sectional," "case-control," and "cohort" according to Strengthening the Reporting of Observational Studies in Epidemiology criteria; and to contribute to the current literature on the subject. Material and methods: This study is planned to use a systematic review format and STROBE checklist was used to evaluate the articles accessed from PubMed database. Microsoft Excel was used as the data calculation tool. Results: Sixty-five (81.3%) of the 80 articles investigated in the scope of this study mention "vaccine." While 64 articles (80%) discuss the determination of vaccine hesitancy, 57 (71.3%) articles address its prevention. The keyword "COVID-19" is used in 61 articles (79.2%). The second most frequently used keyword is "vaccine hesitancy" (n = 37, 48.1%), followed by "vaccine" (n = 25, 32.5%). Twenty-nine (48%) of the reviewed articles originate from the WHO American Continents. The second most represented region of research is the European Region (n = 21, 35%), followed by the South East Asian Region (n = 5, 8%). Conclusion: This study illustrates the recent situation for the coronavirus disease 2019 vaccine and reveals the presence of a vaccine hesitancy. Vaccine hesitancy is a risk factor that could prevent herd immunity. The systematic review of scientific articles should continue with improvements in order to tackle the problem as exemplified by the present study. Other checklists as well as STROBE checklist are recommended to be used in similar studies to have more objective conclusions.
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Background The impact of COVID-19 triggered an unparalleled effort towards the development of a vaccine given that vaccination is currently the most important strategy available for controlling the pandemic. Achieving high levels of vaccination coverage is key to this approach, and requires knowledge of user satisfaction levels. Thus, the objective of this work was to determine the levels of satisfaction with the COVID-19 vaccination program among vaccinated school workers.Methods This was a cross-sectional study which included the staff from educational centres invited for vaccination over 4 days at the Hospital General University Hospital of Alicante. The survey included sociodemographic variables, 13 questions on satisfaction with the vaccination program, and one open question for further suggestions. Satisfaction was calculated globally for each question and specifically by employing Student t -tests; the association between each variable and a high level of satisfaction was analysed with Chi-squared tests. Results Of 9,869 professionals invited, 9,261 attended the appointment; 5,756 were offered the possibility of participating in this survey and 2,989 (51.9%) accepted. The highest overall scores were assigned to the treatment patients received at the ‘registration point’ and the care they received from nurses during the vaccination. The aspect for which the lowest levels of satisfaction were registered was for the information received prior to vaccination. Sex and place of work were significantly associated with a high degree of satisfaction.Conclusions Understanding people’s perception of vaccination programs is essential to implementing improvements and to increase vaccination coverage. The level of satisfaction among school personnel was remarkably high, especially in relation to the treatment and attention they received at different points during the vaccination care circuit.
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Background Vaccines to prevent coronavirus disease 2019 (Covid-19) are urgently needed. The effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines on viral replication in both upper and lower airways is important to evaluate in nonhuman primates. Methods Nonhuman primates received 10 or 100 μg of mRNA-1273, a vaccine encoding the prefusion-stabilized spike protein of SARS-CoV-2, or no vaccine. Antibody and T-cell responses were assessed before upper- and lower-airway challenge with SARS-CoV-2. Active viral replication and viral genomes in bronchoalveolar-lavage (BAL) fluid and nasal swab specimens were assessed by polymerase chain reaction, and histopathological analysis and viral quantification were performed on lung-tissue specimens. Results The mRNA-1273 vaccine candidate induced antibody levels exceeding those in human convalescent-phase serum, with live-virus reciprocal 50% inhibitory dilution (ID50) geometric mean titers of 501 in the 10-μg dose group and 3481 in the 100-μg dose group. Vaccination induced type 1 helper T-cell (Th1)–biased CD4 T-cell responses and low or undetectable Th2 or CD8 T-cell responses. Viral replication was not detectable in BAL fluid by day 2 after challenge in seven of eight animals in both vaccinated groups. No viral replication was detectable in the nose of any of the eight animals in the 100-μg dose group by day 2 after challenge, and limited inflammation or detectable viral genome or antigen was noted in lungs of animals in either vaccine group. Conclusions Vaccination of nonhuman primates with mRNA-1273 induced robust SARS-CoV-2 neutralizing activity, rapid protection in the upper and lower airways, and no pathologic changes in the lung. (Funded by the National Institutes of Health and others.)
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Background The pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) might be curtailed by vaccination. We assessed the safety, reactogenicity, and immunogenicity of a viral vectored coronavirus vaccine that expresses the spike protein of SARS-CoV-2. Methods We did a phase 1/2, single-blind, randomised controlled trial in five trial sites in the UK of a chimpanzee adenovirus-vectored vaccine (ChAdOx1 nCoV-19) expressing the SARS-CoV-2 spike protein compared with a meningococcal conjugate vaccine (MenACWY) as control. Healthy adults aged 18–55 years with no history of laboratory confirmed SARS-CoV-2 infection or of COVID-19-like symptoms were randomly assigned (1:1) to receive ChAdOx1 nCoV-19 at a dose of 5 × 10¹⁰ viral particles or MenACWY as a single intramuscular injection. A protocol amendment in two of the five sites allowed prophylactic paracetamol to be administered before vaccination. Ten participants assigned to a non-randomised, unblinded ChAdOx1 nCoV-19 prime-boost group received a two-dose schedule, with the booster vaccine administered 28 days after the first dose. Humoral responses at baseline and following vaccination were assessed using a standardised total IgG ELISA against trimeric SARS-CoV-2 spike protein, a muliplexed immunoassay, three live SARS-CoV-2 neutralisation assays (a 50% plaque reduction neutralisation assay [PRNT50]; a microneutralisation assay [MNA50, MNA80, and MNA90]; and Marburg VN), and a pseudovirus neutralisation assay. Cellular responses were assessed using an ex-vivo interferon-γ enzyme-linked immunospot assay. The co-primary outcomes are to assess efficacy, as measured by cases of symptomatic virologically confirmed COVID-19, and safety, as measured by the occurrence of serious adverse events. Analyses were done by group allocation in participants who received the vaccine. Safety was assessed over 28 days after vaccination. Here, we report the preliminary findings on safety, reactogenicity, and cellular and humoral immune responses. The study is ongoing, and was registered at ISRCTN, 15281137, and ClinicalTrials.gov, NCT04324606. Findings Between April 23 and May 21, 2020, 1077 participants were enrolled and assigned to receive either ChAdOx1 nCoV-19 (n=543) or MenACWY (n=534), ten of whom were enrolled in the non-randomised ChAdOx1 nCoV-19 prime-boost group. Local and systemic reactions were more common in the ChAdOx1 nCoV-19 group and many were reduced by use of prophylactic paracetamol, including pain, feeling feverish, chills, muscle ache, headache, and malaise (all p<0·05). There were no serious adverse events related to ChAdOx1 nCoV-19. In the ChAdOx1 nCoV-19 group, spike-specific T-cell responses peaked on day 14 (median 856 spot-forming cells per million peripheral blood mononuclear cells, IQR 493–1802; n=43). Anti-spike IgG responses rose by day 28 (median 157 ELISA units [EU], 96–317; n=127), and were boosted following a second dose (639 EU, 360–792; n=10). Neutralising antibody responses against SARS-CoV-2 were detected in 32 (91%) of 35 participants after a single dose when measured in MNA80 and in 35 (100%) participants when measured in PRNT50. After a booster dose, all participants had neutralising activity (nine of nine in MNA80 at day 42 and ten of ten in Marburg VN on day 56). Neutralising antibody responses correlated strongly with antibody levels measured by ELISA (R²=0·67 by Marburg VN; p<0·001). Interpretation ChAdOx1 nCoV-19 showed an acceptable safety profile, and homologous boosting increased antibody responses. These results, together with the induction of both humoral and cellular immune responses, support large-scale evaluation of this candidate vaccine in an ongoing phase 3 programme. Funding UK Research and Innovation, Coalition for Epidemic Preparedness Innovations, National Institute for Health Research (NIHR), NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and the German Center for Infection Research (DZIF), Partner site Gießen-Marburg-Langen.
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Vaccines may reduce the burden of antimicrobial resistance, in part by preventing infections for which treatment often includes the use of antibiotics1–4. However, the effects of vaccination on antibiotic consumption remain poorly understood—especially in low- and middle-income countries (LMICs), where the burden of antimicrobial resistance is greatest5. Here we show that vaccines that have recently been implemented in the World Health Organization’s Expanded Programme on Immunization reduce antibiotic consumption substantially among children under five years of age in LMICs. By analysing data from large-scale studies of households, we estimate that pneumococcal conjugate vaccines and live attenuated rotavirus vaccines confer 19.7% (95% confidence interval, 3.4–43.4%) and 11.4% (4.0–18.6%) protection against antibiotic-treated episodes of acute respiratory infection and diarrhoea, respectively, in age groups that experience the greatest disease burden attributable to the vaccine-targeted pathogens6,7. Under current coverage levels, pneumococcal and rotavirus vaccines prevent 23.8 million and 13.6 million episodes of antibiotic-treated illness, respectively, among children under five years of age in LMICs each year. Direct protection resulting from the achievement of universal coverage targets for these vaccines could prevent an additional 40.0 million episodes of antibiotic-treated illness. This evidence supports the prioritization of vaccines within the global strategy to combat antimicrobial resistance8. Pneumococcal and rotavirus vaccines have reduced antibiotic consumption substantially among children under five years old in low- and middle-income countries; however, this effect could be doubled if all countries were to implement vaccination programmes and meet universal vaccine coverage targets.
Article
The debate around vaccines has been in the spotlight over the last few years in Europe, both within the scientific community and the general public debate. In this regard, the case of the Italian vaccination debate is particularly worrying given that Italy has been one of the European countries with the highest number of measles cases in the recent past. According to this scenario, we conducted a cross-sectional study on a convenience sample of Italian university students aimed at: (1) exploring their attitudes towards a future vaccine to prevent COVID-19 and; (2) evaluating the impact of the university curricula (healthcare vs. non-healthcare curricula) on the intention to vaccinate. Descriptive analysis on the 735 students that answered to the question on the intention to vaccinate showed that 633 (86.1%) students reported that they would choose to have a vaccination for the COVID-19 coronavirus; on the other side, 102 (13.9%) students reported that they would not or be not sure to vaccine (low intention to vaccinate). This means that in our sample more than one student out of 10 shows low intention to vaccinate (vaccine hesitancy). Furthermore, when running analysis comparing healthcare students versus non-healthcare students we found no significant differences in responses’ percentage distribution (p = .097). Understanding the student’s perspective about the future COVID-19 vaccine and supporting their health engagement and consciousness may be useful in planning adequate response and multidisciplinary educational strategies—including the psychological perspective on vaccine hesitancy underlying factors - in the post-pandemic period.
Article
Despite major advances in vaccination over the past century, resurgence of vaccine-preventable illnesses has led the World Health Organization to identify vaccine hesitancy as a major threat to global health. Vaccine hesitancy may be fueled by health information obtained from a variety of sources, including new media such as the Internet and social media platforms. As access to technology has improved, social media has attained global penetrance. In contrast to traditional media, social media allow individuals to rapidly create and share content globally without editorial oversight. Users may self-select content streams, contributing to ideological isolation. As such, there are considerable public health concerns raised by anti-vaccination messaging on such platforms and the consequent potential for downstream vaccine hesitancy, including the compromise of public confidence in future vaccine development for novel pathogens, such as SARS-CoV-2 for the prevention of COVID-19. In this review, we discuss the current position of social media platforms in propagating vaccine hesitancy and explore next steps in how social media may be used to improve health literacy and foster public trust in vaccination.
Article
Background The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in late 2019 and spread globally, prompting an international effort to accelerate development of a vaccine. The candidate vaccine mRNA-1273 encodes the stabilized prefusion SARS-CoV-2 spike protein. Methods We conducted a phase 1, dose-escalation, open-label trial including 45 healthy adults, 18 to 55 years of age, who received two vaccinations, 28 days apart, with mRNA-1273 in a dose of 25 μg, 100 μg, or 250 μg. There were 15 participants in each dose group. Results After the first vaccination, antibody responses were higher with higher dose (day 29 enzyme-linked immunosorbent assay anti–S-2P antibody geometric mean titer [GMT], 40,227 in the 25-μg group, 109,209 in the 100-μg group, and 213,526 in the 250-μg group). After the second vaccination, the titers increased (day 57 GMT, 299,751, 782,719, and 1,192,154, respectively). After the second vaccination, serum-neutralizing activity was detected by two methods in all participants evaluated, with values generally similar to those in the upper half of the distribution of a panel of control convalescent serum specimens. Solicited adverse events that occurred in more than half the participants included fatigue, chills, headache, myalgia, and pain at the injection site. Systemic adverse events were more common after the second vaccination, particularly with the highest dose, and three participants (21%) in the 250-μg dose group reported one or more severe adverse events. Conclusions The mRNA-1273 vaccine induced anti–SARS-CoV-2 immune responses in all participants, and no trial-limiting safety concerns were identified. These findings support further development of this vaccine. (Funded by the National Institute of Allergy and Infectious Diseases and others; mRNA-1273 ClinicalTrials.gov number, NCT04283461).
Article
Objectives When assessing the economic value of vaccines, decision makers should adopt a full societal perspective. One approach for estimation of the fiscal impact of a disease is to use the human capital method to determine productivity losses. The aim of this study was to test an analytical framework developed for the estimation of the fiscal impacts of vaccination programs for influenza (FLU), pneumococcus (PC), and herpes zoster (HZ), in Italy. Methods We tested the framework in a two-stage analysis. First, we estimated the fiscal impact of the disease, second we performed a cost–benefit analysis of the individual benefits of vaccination against the cost of the vaccine. To estimate the fiscal impact of the diseases, the human capital approach was used. Epidemiological data were extrapolated from the literature. A Monte Carlo simulation enabled exploration of the uncertainty in the model variables. Results For FLU, assuming 2.1 million people infected, the total expected impact was EUR 999,371,520; the estimated fiscal impact was EUR 159,563,520. For PC, assuming 90,000 people infected, the total impact was EUR 148,055,040 and the estimated fiscal impact was EUR 23,639,040. For HZ, assuming 6,400 people infected, the total impact was EUR 4,777,200, with EUR 630,000 resulting from a decrease in fiscal taxation. Conclusions In conclusion, our work shows how traditional methods aimed at estimating the cost of illness from a social perspective can be improved by additionally considering the fiscal impact, which accounts for the decrease in fiscal revenues due to illness.